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BILL OF LADING/MANIFEST 1.shipper's US EPA iD No.(If Applicable) Document No 2.page 1 <br /> 9L q.q of <br /> 3.Shipper's Name and Mailing Ad&-zs ' <br /> _ ALP _ <br /> TRAC:Y <br /> 9 36--1971 <br /> 4.Shipper's Phone( _0 <br /> 5.Transporter 1 Company Name 6. US EPA ID Number A.Transporter's Phone <br /> LSI ty 'YSTEMS, IN, 800 669-5740 <br /> 7.Transporter 2 Company Name 8. US EPA ID Number 6 Transporter's Phone <br /> 9.Desi Hated Facility Name and Site Address 0 5 07 0 10. US EPA iD Number C.Facility's Phone <br /> LT", i,,Li L L t� "JiL, INC- . <br /> 6880 SMITH AVE . <br /> NEWARK t:A 94560 CA1.3960 fir;741£"3 biO `195-4400 <br /> 11 Shipping Name and Description 12.Containers 13. 14. <br /> Total Unit <br /> HM No, Type Quantity Wt/Voll <br /> a. NuN- EGULATED LIQUID NOT <br /> USDOT -REGULATED MATERIA. <br /> ( VAC-OIL, WATER, SLUDGE <br /> b. <br /> S <br /> 11 <br /> 1 c. <br /> P <br /> P <br /> E <br /> R d <br /> 15.Special Handling Instruction and Additional Information <br /> MFST R{T#109308664 0000- 3701-02 <br /> i�tERt;ENt::Y REEF' 600-468-1760( 24 HR ) . <br /> -Pt' Al1TI1C'Q1ZED TO RETAIN LICENSED SUBSEQUENT CARRIERS AS NECESSARY. <br /> SKDOT# A: 3239 B: C : D: <br /> /96 <br /> 16a.US DOT HAZARDOUS MATERIALS SHIPPER'S CERTIFICATION' "this is tc certify that the above-named matedais ere propedy classified,dasc lbed,packmar <br /> aged, ked and labeled and are in proper <br /> _ - ondition for trans dation acca rd..q to the applivable re Mations ofthe ce o artment.of Trans ori ation. <br /> PrintedlTyped Name Month Day Year <br /> 16b.NON-REGULATED SHIPPER'S CERTIFICATION: I certify the materials described above on this form are not subjacs to federaitregulations for Transportation or Disposal. <br /> • Printed/Typed Name Month Day yeas • <br /> G'" �et A1C !�� ■• ©C1 <br /> T 17.Transporter 1 Acknowledgement of Re pt of M erials <br /> R <br /> A riMedlTyped Name S3 store Month Day Year <br /> P f", <br /> IF <br /> 0 18.Transp&jr 2 Acknowledgement of Recei 1 of Materials <br /> R Printed/Typed Name Signature Month Day year <br /> E <br /> R <br /> 19.Discrepancy Indication Space <br /> F <br /> A <br /> C <br /> I - <br /> L 20.Facility Owner or Operator:Certification of receipt of materials covered by this form except as noted in Item 19. <br /> t <br /> PrinInped Name , ignature �� +� Month Day Year <br /> • <br /> ORIGINAL-RETURN TO GENERATOR FORM NO.90291(11196) <br />